Dealing With COVID-19 Patients: A Moderated Mediation Model of Exposure to Patients' Death and Mental Health of Italian Health Care Workers

Abstract

Introduction: The COVID-19 pandemic is asking health care workers (HCWs) to meet extraordinary challenges. In turn, HCWs were experiencing tremendous psycho-social crisis as they have had to deal with unexpected emotional requirements (ERs) arising from caring for suffering and dying patients on a daily basis. In that context, recent studies have highlighted how HCWs working during the COVID-19 outbreak manifested extreme emotional and behavioral reactions that may have impacted their mental health, increasing the risk for developing post-traumatic stress symptoms.Purpose: The aim of the study was to investigate post-traumatic stress symptoms, such as intrusion symptoms, as a potential mediator of the link between ERs and crying at work, and whether rumination moderates the relationship between ERs and intrusion-based PTS symptoms among HCWs who have had to deal with patients dying from COVID-19.Methods: An online cross-sectional study design was performed. A total of 543 Italian HCWs (physicians and nurses) participated in the study. Participation was voluntary and anonymous. We used the SPSS version of bootstrap-based PROCESS macro for testing the moderated mediation model.Results: ERs had an indirect effect on crying at work through the mediating role of intrusion symptoms. Results from the moderated mediation model showed that rumination moderated the indirect effect of ERs on crying at work via intrusion symptoms, and this effect was significant only for high rumination. Furthermore, when we tested for an alternative model where rumination moderates the direct effect of ERs on crying at work, this moderation was not significant.Conclusions: As the second wave of the COVID-19 pandemic is ongoing, there is an urgent need for decision-makers to rapidly implement interventions aimed at offering timely psychological support to HCWs, especially in those contexts where the risk of emotional labor associated to patients dying from COVID-19 is higher.

“We All Held Our Own”: Job Demands and Resources at Individual, Leader, Group, and Organizational Levels During COVID-19 Outbreak in Health Care. A Multi-Source Qualitative Study

“…Job demands and resources were found at individual, group, leader, and organizational level, as shown in Table 1 . At individual level, emotional load aligns with recent findings about influence of pandemic fear of death and exposure to sufferance ( Portoghese et al, 2021 ) on health care workers’ mental health. Our study suggests additional concerns to consider, namely, those for infected colleagues, families, and misdiagnosing.…”

“…In Italy, as of July 2021, 136,786 infection cases have been documented among health care workers ( Istituto Superiore di Sanità, 2021 ), who were the most frequently affected occupation by COVID-19 ( Istituto Nazionale Assicurazione Infortuni sul Lavoro, 2020 ). Pandemic infection and witnessing of death and sufferance constitute a serious challenge to health care workers’ mental health ( Portoghese et al, 2021 ). Several studies have shown the impact of COVID-19 on Italian health care workers’ mental health ( Babore et al, 2020 ; Barello et al, 2020 ; Bettinsoli et al, 2020 ; Makowiecki et al, 2020 ; Rossi et al, 2020 ; Trumello et al, 2020 ) and found how stressful the pandemic experience has been for these workers due to many risk factors.…”

Differences Between the Psychological Symptoms of Health Workers and General Community After the First Wave of the COVID-19 Outbreak in Spain

“…Similar results were described by Wang et al (2020), who evaluated 1,210 participants from almost 200 cities in China using the DASS-21 questionnaire, finding that 53.8% of those surveyed rated the psychological impact of the outbreak as moderate or severe. Last, similar results for healthcare workers have been found all over the world, e.g., Switzerland (Weilenmann et al, 2021) or Italy (Portoghese et al, 2021), among others. After the first wave in Spain, the current results also suggest higher levels of distress among healthcare workers, while psychologists seem to be more resistant to this situation.…”

The impact of impulsivity and school attendance on COVID‐19 spread: A web‐based cross‐sectional questionnaire

“…COVID‐19‐related deaths affect the relatives of patients as well as the healthcare staff. Studies have shown that posttraumatic stress symptoms increase and cause emotional and behavioral changes in healthcare professionals who witness the deaths of COVID‐19 patients (Mosheva et al, 2021 ; Portoghese et al, 2021 ). Finally, fear of COVID‐19 was consistently found to be the primary predictor of beneficial behavior change (e.g., social distancing and enhanced hand cleanliness), with no effect from politically significant variables (Harper et al, 2020 ).…”